Payments for Residential Supports do not include payments for room and board, the cost of facility maintenance and upkeep.

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1 Residential Supports: Level 1 and Level 1 AFL - H2016; Level 2 and Level 2 AFL - T2014; Level 3 and Level 3 AFL - T2020; Level 4 and Level 4 AFL - H2016HI; Level 5 and Level 5 AFL T2016HI Residential Supports consist of an integrated array of individually designed training activities, assistance and supervision. Residential Supports include: (1) Habilitation Services aimed at assisting the individual to acquire, improve, and retain skills in self-help, general household management and meal preparation, personal finance management, socialization and other adaptive areas. Training outcomes focus on allowing the individual to improve his/her ability to reside as independently as possible in the community. (2) Assistance in activities of daily living when the individual is dependent on others to ensure health and safety. (3) Habilitation services that allow the individual to participate in home life or community activities. Transportation to and from the residence and points of travel in the community is included to the degree that they are not reimbursed by another funding source. Residential Supports may additionally be provided in an Alternative Family Living (AFL) situation. The site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for the cost of care. These sites are licensed or unlicensed in accordance with state rule. All AFL sites will be reviewed using an AFL checklist for health and safety related issues. Alternative Family Living residential support providers are limited to three beds or less. Residential Supports is provided in licensed residential settings which demonstrate a home and community character. Exclusions Transportation to/from a child s school is the responsibility of the school system rather than the Residential Supports Provider. Transportation to/from medical appointments is billed to State Medicaid Plan Transportation rather than Residential Supports. Individuals who receive Residential Supports may not receive Home Modifications, In-Home Intensive Supports, In-Home Skill Building, Personal Care Services, Respite, Vehicle Modifications, or State Plan Personal Care Services. Payments for Residential Supports do not include payments for room and board, the cost of facility maintenance and upkeep. This service is not available at the same time of day as Community Networking, Day Supports, Supported Employment or one of the State Plan Medicaid services that works directly with the person. Limits on amount, frequency, or duration The amount of Residential Supports is subject to the Limits on Sets of Services and individual budget category as specified in Chapter 8. The amount of Residential Supports also is subject to the amount of person s Support Needs Category Budget as specified in Chapter 8.

2 Service Delivery Method Implementation Tips Provider Directed Individual/Family Directed Residential Supports are provided to individuals who live in a community residential setting. Residential Supports may be provided in homes serving one individual. For the purposes of the Cardinal Innovations Waiver, an AFL for one person is provided as an out-of-home placement for a person who chooses this setting or whose family cannot provide care for that person. The individual receives 24-hour care from and lives in a private home with family in a home environment where services for the care and habilitation of the individual. The home does not require license because it serves only one adult with a developmental disability. Homes serving one child (under the age of 18) require licensure. With the effective date of April 1, 2010, individuals in this waiver must live in private homes or in facilities with six or fewer licensed beds Individuals participating in the waiver at the time of renewal, April 1, 2008 who were living in facilities with no more than eight licensed beds at the time of the renewal may continue to live in the facility that they were living in at that time. Individuals from expansion LME s/counties entering the waiver on their respective phase in dates (October 1, 2011; January 1, 2012; or April 1, 2012), who were receiving Residential Supports in facilities seven to ten beds, may participate in the Cardinal Innovations waiver and receive Residential Supports. Facility capacity for all newly developed facilities, effective 4/1/2008 in the current PBH area and effective 11/1/2008 in areas served by the CAPMR/DD Comprehensive waiver, is 3 beds or less. New residential facility is defined as new construction or newly licensed. Facility capacity for existing facilities approved within the PBH Network, facility size in six beds or less. A home and community environment is characterized as an environment like a home, provides full access to typical facilities in a home such as a kitchen with cooking facilities, small dining areas, provides for privacy, visitors at times convenient to the individual and easy access to resources and activities in the community. Group homes are expected to be located in residential neighborhoods in the community. Meals are served family style and individuals access community activities, employment, schools or day programs. Each facility shall assure to each individual the right to live as normally as possible while receiving care and treatment. This process will be monitored by PBH and Care Coordinators. Care Coordinators report results of their monitoring to PBH Quality Management Department. Additionally the PBH Quality Management Department monitors facilities over six beds to assure the home and community environment. Providers found out of compliance will be

3 given a time line in which to come into compliance. Results of the monitoring are included in the Cardinal Innovations monitoring reports to DMA. The Daily Rate is paid for individuals who are present in the home at midnight. Daily rates include payments for relief staff that provide support for the individual in the group home or alternative family living home. Transportation to and from a licensed day program is the responsibility of the Residential Supports provider. Provider Type License Certification Other Standard Facilities for the Mentally Ill, Developmentally Disabled and Substance Abusers group homes NC G.S. 122C NC G.S. 122 C Approved as a provider in the PBH provider network Agency staff that work with Individuals: High school diploma or high school equivalency (GED) Are at least 18 years of age If providing transportation, have a valid NC driver s license or other valid driver s license, a safe driving record, has an acceptable level of liability insurance Criminal background check present no health and safety risk to individual Not listed in the North Carolina Health Care Abuse Registry Qualified in CPR and First Aid and the customized needs of the individual as described in the ISP Paraprofessionals providing this service must be supervised by a qualified professional. Super-vision must be provided according to the requirements specified in 10A NCAC 27G.0204 and according to licensure or certification requirements of the appropriate

4 discipline. Associate professionals are grandfathered through 3/31/2012. Enrolled to provide crisis services or has an arrangement with a crisis services provider to respond to individual crisis situations. The individual may select any enrolled crisis provider in lieu of this provider however. Within 1 year of January 1, 2011 or enrollment as a provider, the organization must have achieved national accreditation with at least one of the designated accreditation agencies. The organization must be established as a legally constituted entity, capable of meeting all requirements of PBH. Facilities for the Mentally Ill, Developmentally Disabled and Substance Abusers Alternative Family Living Homes (AFL) NC G.S. 122 C NC G.S. 122 C Agency staff that work with individuals: Are at least 18 years of age If providing transportation, have a valid North Carolina driver s license or other valid driver s license and a safe driving record and has an acceptable level of automobile liability insurance Criminal background check present no health and safety risk to individuals Not listed in the North Carolina Health Care Abuse Registry Qualified in CPR and First Aid and the customized needs of the individual as described in the ISP High school diploma or high school

5 equivalency (GED) Paraprofessionals providing this service must be supervised by a qualified professional. Supervision must be provided according to the requirements specified in 10A NCAC 27G.0204 and according to licensure or certification requirements of the appropriate discipline. Associate professionals are grandfathered through 3/31/2012. Enrolled to provide crisis services or has an arrangement with a crisis services provider to respond to individual crisis situations. The individual may select any enrolled crisis provider in lieu of this provider however. Within one year of January 1, 2011 or enrollment as a provider, the organization must have achieved national accreditation with at least one of the designated accreditation agencies. The organization must be established as a legally constituted entity, capable of meeting all the requirements of PBH. Site must be the primary residence of the AFL provider (includes couples and single persons) who receive reimbursement for cost of care. Back-up staff must be employees of the agency. AFL Residential Supports providers are limited to three beds or less.